06050216 CITY OF CUPERTINO � aygubFnr�' "'�"'" '-`�" ��'
BUILDING DIVISION PERMITCONTRACTORINF'ORMATIQI�
B UIIDwG ADDRESS: STEVE NAN CONSTRUCTION "MIT NO 06050216
10148 BRET AVE
'IER'S NAME: PERMpp SSUE DATE
SHIAO MEI NAN LLC 919 LORNE WAY 06/14/2006
PHONE SANITARY NO, CONTROL NO.
(408) 203-3933
ARCHnECT/ENGINEER: BUILDING WRMrr INFV
BLDG ELECT PLUMB MECH
_OZ LICENSED CONTRACTORS DECLARATION J
W 1 hertby.Rrm Wu 1 Wo Exud unkr pmvioims a(OIpIG 9(mnumneing .
O
IW Smkn 70fp)aDivkloa]of do Bek uad Profcukaa Cade.ad mylk�.ls
nfull raaadeH¢ DEMO OF SFDWL
,fSp? Lkctm Clau Lic.Y
qDam — — �nucmr AUL C
�C W ARC f1ELTs OECLA /, ZOoU
��Ct Imb<sua«I my pWushau be tndugWl&rcmdr fgPPffyy��r o{/fy�)� u
a O t' Licmxd Rofcubvl
OWNER-BUILDER DECLARATION
1 h,Mby affirm Wu I am exempt from de ComlaClarl U Lw for Bc
00 folntrinL muom(Ssuan 70]I.S,Budtns.nd Pmfcsvoo Cada:Myiy«camsy
9 whkh mgaires a pormit to«mown,abur.h tP .dcmdiab,m mpvir any sonmtm $10000
_zr 'iorW uiouancc.ako rtyuims Wc.ppkvr fm.ch pctmit m ftk.sigmd alHenml
< 0,be is lkcrurd Mroamto We pm.istmn of We Corpoac ri Lice.U.(a.prm 9 Sq. Ft. Floor Area Valuation
YFO (cor.m S lb Semon 700%a Division J a NC Boo.ad Pmfcoimu Cady-
$ Wu d k e oOmpt Bcrcfrom.d the buffs for We alkged armpdarc Any v'aala w a
Seim 7071.5 by my apPlk'ans f«a ptomit subje the appliam b a NHI penally a Occupancy Type
not rrc O than Ba bodred ddl.rs(SSW}
❑L v owmr df We pmpmty,«my wployce wbh ngp u Wev sok mmpertadon.
loOl da Wewor
.d Pmf « CmThe La Law e kapply to..anox eaa Required InsIKctions
OW,oR j o a,�m«imp t,such hmn,sdwho doesouchwort ho,cfflflR1f- gn his
Owneopbym,dmga op amh'vnpmvemmu arems lsaevdm Pa km.fm ala If,
boweve.We bniking«i.pmvsrtovuIssold Malin orc)ear of cm or,o for
Weowmrf
bu0dm wtT Wath boNcn a poNng dot he did ort bend«impure f«yryo¢of
vlr_l.
❑1,a OW,,of We propm,w mcircl canuaming MW Ikeued cm,....,,..to ,
consuact do project(Sec.70M.Btorrra and Pmfad=Cade:)The Caasssoals U-
..Lw dao em apply to N.a property who A Or baproas Bemco.ad.
who mmucu fa vd pmjeeu wbh ammuaet«(s)I d pussasnt to We C'aaROWara
Lit.law.
❑Ilmn—,,,unde See .Bd Pcfo Odssosm
Due
WORKERS MMPENSA71ON DECLARATION
I hcmby affirm under pev4y a P-Jory Orc a tic 1-HOWIng declaNioru:
I W a ad wW malnuiv a Cerdfiae W Canzm m self-IrnmO fa WortCsCwnpery
satim,r«
.ar.Provided(«mi Seim 7'!00 a We labor Code.f«de pesformamz a do
rt nicb wa anah is i:»a
❑I nate ad MH..jr ab Wr kes Compeaudm In„urce.u rc,Wred by
Jiflo a do labor Code.for We pcd..rue ftbo w«k f«which alis Mrmis u--aA
My Warkrls Co pc minaa.raz ad Policy bast
Cartier: L!/'I policy
CE aEOF Ey FMVr10N FROM wORKERS
COMPENSATION INSURANCE
fTnc acini nttd rot be mmPktW U We pvmn is for one hWOd doRan RI W)
I certify Wt u Ne pefarm.na d the Work fa wmm Bds ry.[%b Isand.I Shall mr
mplry.ny M.n In any maarrtr so al to Mmme vbjat W Bre WOM1VY Canp-M„m
Laws of Calirorm..Due
Applicant
NOTICE TO APPLICANT:Ir,srcr..umg Wlo ccnifiae or E cmpuao,ym abmb
neOonc sobjcm to We warkela Cmapeneuon pvnv doRa a Bc labor Code.you mm
Ofanhwi b comply MW such Movruana or Bda Mr Til ah.11 bc dccncd m lccd.
z "' CONSTRf/Cf10N LENDING AGENCY
E 41 bercby ainom Bus throe u.mnmunlnn kding.gescy for she PMma oanof
pv> du work for which ws Permit ci fvued(Sx.7097,Cm C-)
0. Q 1� a Name '
z Lcdcfa Aadrrn
U0 I O tify duet 1 hate rad Wis application ad suit Wt the�iafam otic.u
F cartm:l.i agme to comply w W all city and county aNinance ad sou Ian rtlating to
0 bulldiag c..d.n,W Omby.aWadre rc,.Oadv d this dry m cmar upm Nc
a ¢boa-rmduxtl pmMrty for HOMCCUOR purpose&
(Wc)agme b vve.idemnify and trsp haemkas We City of CupermR.0.
H r/1 OabWtk&lmgmcob.coasand capcmc;which may in any Way amm.a.,said City
U ie coraqumco of tW grams,a thu pmmit. Date
^� APPLICANT UNDERSTANDS AND WILL COM m Y WrALL NON-POINT Issued by: .
SOURCEREGULI
�� Re-roofs
S
HAZARDOUS MA7FRIA1SDI5CLOSURE Type of Roof
W W We applicant a to.building O.Rpans nve«Ndk huadws maurial
u dafmd by OR,Cuperdm MWdcipal Cock.Cnaper 9.12 and the Heald,ad Safmy
.Seim 255]24)7 All roofs shall be inspected prior to any roofing material being installed.
❑Ya AN.
a ip l or fubm building occupant us wolp�«da.laa whkh If a roof is installed without firs[obtaining an inspection,I agree to remove
WII ala
emit harardow air conumimnu v&c by tK Bay Are Air Qtollly Managcmcm all new materials for inspection.
Oissrfn7
CYa Nu
1 baa mad ds harudwo masvi.ls tequuememsun@TCW ptr 495 orale CaNfor-
ma HdWh SsfayCodc,S=mi 25505,25377 ad 255X.1 urdcmad W.tirOc bmldiag
Ssa oc' m as ovara,Jut It a my Nluy u.dry dte o¢apat a do
mqubcmom n<^te a.cwlkateofocSignature ofApplicant Date
All roof coverings to be Class"B"or better